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Date. 3o iz _ <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) <br /> PROSECT NAME: 6xkzin '-?- 3942— WELL NUMBER <br /> PROJECT NUMBER- g000 7-Z9- Mo g <br /> PERSONNEL-- <br /> SAMPLE <br /> ERSONNEL SAMPLE DATA: <br /> TIME SAMPLED 1 33 c <br /> DEPTH SAMPLED (ft)_ — 35? 69ek <br /> SAMPLING EQUIPMENT T-40-2 SOL" 'e? 10a' le f <br /> COMMENTS rte <br /> i <br /> NO OF CONTAINER RELA VOLME SHIPPED UNDER ANALYSIS <br /> SAMPLEHO GO80 OF RS TYPE PRESERVATIVE FILTRATION RLLED TURMD"Y COLOR CHAIN OE CUSTO()Y REOUFST COMMENTS l <br /> ll <br /> / fiar l) AT VC(Y" (UETHOO) <br /> 3 VOA HCC \ <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (gal)- < <br /> DISPOSAL METHOD- 55 �evt G{rt�m <br /> DRUM DESIGNATION(S)NOLUME <br /> COMMENTS- <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO, add comments) <br /> WELL SECURITY DEVICES OK (BOLLARDS, CHRISTY LID, CASING LID AND LOCK)?-.�€ NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?. <1UP NO <br /> WELL CASING OK?: eT NO <br /> COMMENTS l- <br /> _ 1 <br /> GENERAL <br /> WEATHER CONDITIONS <br /> TEMPERATURE(specify'CrF)_ jgg�- <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? rits2- <br /> COMMENTS <br /> c-c. Project Manager <br /> Job File <br /> Other_ <br />